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The effect of antenatal corticosteroids in triplet pregnancies on fetal growth, survival and neurodevelopmental outcome

Presented at the Neonatal Society 2001 Summer Meeting (programme).

D'Amore A1, Ahluwalia JS1, Cheema I1, Kaptoge S2, Kelsall AW1

1 Neonatal Intensive Care Unit, Rosie Maternity Hospital, Hills Rd, Cambridge.
2 Centre for Applied Medical Statistics, University of Cambridge Institute of Public Health, Robinson Way, Cambridge.

Background: The incidence of triplet pregnancies has increased as a result of infertility treatment. Advances in obstetric and neonatal intensive care including the use of antenatal corticosteroids and postnatal surfactant have resulted in improved survival in premature infants (1). Concerns have been raised that multiple courses of antenatal corticosteroids may have adverse effects on fetal growth and longer term neurodevelopment (2). There are few data on their use in multiple pregnancy.

Aim: To review the outcome of triplet pregnancies, and in particular determine the impact of antenatal steroids on fetal growth, survival and developmental outcome.

Methods: Retrospective case note review of infant and maternal records following admission to a single tertiary neonatal unit.

Results: Sixty triplet pregnancies were identified over 14 years (1986-1999). 173 live births were included in the analysis and divided into groups according to maternal antenatal corticosteroid exposure.

156 infants (90%) of live triplet births survived to discharge. In 46 pregnancies (76%) all the triplets survived. Survival at greater than 28 weeks was 98.9%. The overall perinatal mortality rate for this cohort was 92/1000 live births. Data on neurodevelopmental outcome at 1 year were available for 143 survivors (91%), only 5 infants had documented problems. 3 infants had spastic diplegia and 1 infant had hydrocephalus; these were in the non-steroid group. Chi -square test and probability models showed that only gestation had a significant effect on survival. There was no significant effect of steroid exposure on head circumference at birth or on fetal growth restriction.

Conclusion: Survival from triplet pregnancy is high. Antenatal steroids are not associated with adverse outcome.

1. Crowley PA. Antenatal corticosteroid therapy: a meta-analysis of the randomised trials, 1972-1994. Am J Obstet Gynecol 1995;173:322-35.
2. French N, Hagan R, Evans S, Godfrey M, Newnham J. Repeated antenatal corticosteroids: size at birth and subsequent development. Am J Obstet Gynaecol 1999;180:114-21

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